title: Quality use of medicines and health outcomes among a cohort of community dwelling older men: an observational study.
abstract: OBJECTIVE
  To determine the prevalence of potentially suboptimal medication use and association with adverse outcomes.
  
  
  METHODS
  A prospective, observational cohort study of 4260 community-dwelling older men from Perth, Western Australia (mean age of 77 ± 3.6 years) was conducted. Follow-up was for 4.5 years (or until death, if sooner). Cox proportional hazard models were used to explore associations between suboptimal medication use and prospective clinical outcomes. Logistic regression analyses were used to explore predictors of a fall in the previous 12 months.
  
  
  RESULTS
  Use of potentially inappropriate medicines (48.7%), polypharmacy (≥5 medications, 35.8%) and potential under-utilization (56.7%) were highly prevalent, and overall 82.3% of participants reported some form of potentially suboptimal medication use. A self-reported history of falls in the previous 12 months was independently associated with the number of medicines taken (odds ratio [OR]= 1.06, 95% confidence interval [CI] 1.02, 1.09) and use of one or more potentially inappropriate medicines (OR = 1.23, 95% CI 1.04, 1.45). After adjusting for age, co-morbidity, smoking status, body mass index, hypertension and educational attainment, the number of medicines reported was associated with admission to hospital (hazard ratio [HR]= 1.04, 95% CI 1.03, 1.06), cardiovascular events (HR = 1.09, 95% CI 1.06, 1.12) and all cause mortality (HR = 1.04, 95% CI 1.00, 1.07). Use of one or more potentially inappropriate medicines was associated with admission to hospital (HR = 1.16, 95% CI 1.08, 1.24). Potential under-utilization was associated with cardiovascular events (HR = 1.20, 95% CI 1.03, 1.40).
  
  
  CONCLUSIONS
  These data suggest that both medication over-use and under-use occur frequently among older men and may be harmful.
authors.affiliation: Western Australian Centre for Health and Ageing, Centre for Medical Research, Western Australian Institute for Medical Research, Perth, WA, Australia. cdbeer@graduate.uwa.edu.au
authors.forename: Christopher
authors.initials: C
authors.lastname: Beer
authors.forename: Zoë
authors.initials: Z
authors.lastname: Hyde
authors.forename: Osvaldo P
authors.initials: OP
authors.lastname: Almeida
authors.forename: Paul
authors.initials: P
authors.lastname: Norman
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Hankey
authors.forename: Bu B
authors.initials: BB
authors.lastname: Yeap
authors.forename: Leon
authors.initials: L
authors.lastname: Flicker
mesh_terms: D000058:Accidental Falls / Q000401:mortality / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D005853:Geriatrics; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008508:Medication Errors; D004366:Nonprescription Drugs / Q000009:adverse effects*; D019338:Polypharmacy; D055553:Prescription Drugs / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D014904:Western Australia
chemical_list: D004366:Nonprescription Drugs; D055553:Prescription Drugs